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Publisher: Elsevier   (Total: 3175 journals)

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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 376, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 235, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 10)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 14, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 1, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 375, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 333, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 429, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 189, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Medicine
  [SJR: 2.023]   [H-I: 189]   [42 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
   Published by Elsevier Homepage  [3175 journals]
  • Do We Learn More from Our Mistakes than from Our Successes'
    • Authors: Joseph S. Alpert
      Pages: 331 - 332
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Joseph S. Alpert


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.01.004
       
  • Predatory Publishing: What Are the Alternatives to Beall's List'
    • Authors: Wadim Strielkowski
      Pages: 333 - 334
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Wadim Strielkowski


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.054
       
  • Hypertension Treatment Controversies in the Oldest Old
    • Authors: Raya E. Kheirbek
      Pages: 335 - 336
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Raya E. Kheirbek


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.018
       
  • Early Worsening of Renal Function After Treatment with Antihyperglycemic
           Drugs: A Consistent Finding in Large-Scale Trials
    • Authors: Milton Packer
      Pages: 337 - 338
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Milton Packer


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.020
       
  • Introduction to Neuroimaging
    • Authors: Elizabeth George; Jeffrey P. Guenette; Thomas C. Lee
      Pages: 346 - 356
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Elizabeth George, Jeffrey P. Guenette, Thomas C. Lee
      Primary care physicians are often tasked with evaluating neurologic symptoms, and imaging plays a critical role in neurologic diagnoses. Neuroradiology routinely employs advanced imaging modalities, and hence, determination of the appropriate imaging test and interpretation of findings in the clinical context can understandably be overwhelming. In this review article, we introduce resources that can guide physicians in the selection of neuroimaging tests and summarize guidelines on contrast agent administration. Key concepts on imaging techniques and terminology are reviewed, as is relevant for the primary care physician. We then present an overview of the typical imaging manifestations of brain pathologies, including stroke, traumatic injuries, infections, demyelinating and neurodegenerative processes, and neoplasms. Spine imaging is often considered for the evaluation of degenerative, infectious, or neoplastic etiologies, and the typical imaging findings in these scenarios are also summarized.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.11.014
       
  • Oncologic 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed
           Tomography: What All Physicians Need to Know
    • Authors: Jaime L. Montilla-Soler; Rikesh J. Makanji; Bruce J. Barron
      Pages: 357 - 364
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Jaime L. Montilla-Soler, Rikesh J. Makanji, Bruce J. Barron
      Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) hybrid examinations (PET/computed tomography, PET/magnetic resonance imaging) have become the most common PET imaging tools in the evaluation of the oncologic patient. Therefore it is of paramount importance that physicians who take care of oncology patients in any capacity are familiar with the basics of when these examinations are indicated, know how to best prepare the patients, and understand the benefits and limitations of the procedure. Additionally, it is important to understand which medical conditions and medications need to be controlled to maintain the diagnostic accuracy of these tests. In this article we aim to explain what 18F-FDG is, how to best prepare our patients, what PET is, and how these examinations are interpreted. Finally, we discuss some of the limitations of these examinations.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.12.006
       
  • Dietary Sodium Interventions to Prevent Hospitalization and Readmission in
           Adults with Congestive Heart Failure
    • Authors: Wilbert S. Aronow; Tatyana A. Shamliyan
      Pages: 365 - 370.e1
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Wilbert S. Aronow, Tatyana A. Shamliyan


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.12.014
       
  • No More ‘Code Black’: Intervention to Improve Inpatient Flow
           at a Large Public Hospital
    • Authors: Charles E. Coffey; Valda Carter; Eric Wei; Douglass Hutcheon; John P. Gruen; Annie Anonas-Ternate; Rebecca Sandoval; Annie Marquez; Laura Sarff; Brad Spellberg
      Pages: 371 - 376
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Charles E. Coffey, Valda Carter, Eric Wei, Douglass Hutcheon, John P. Gruen, Annie Anonas-Ternate, Rebecca Sandoval, Annie Marquez, Laura Sarff, Brad Spellberg


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.050
       
  • Wounds That Would Not Heal: Pyoderma Gangrenosum
    • Authors: Joanie Pinard; David Y. Chiang; Arash Mostaghimi; Scott R. Granter; Joseph F. Merola; Ebrahim Barkoudah
      Pages: 377 - 379
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Joanie Pinard, David Y. Chiang, Arash Mostaghimi, Scott R. Granter, Joseph F. Merola, Ebrahim Barkoudah


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.12.009
       
  • Site-Seeing: Hereditary Hemorrhagic Telangiectasia with Native-Valve
           Endocarditis
    • Authors: Teiko Kawahigashi; Sho Nishiguchi; Joel Branch; Kazuki Hiramitsu; Takayuki Niitsu; Izumi Kitagawa
      Pages: 380 - 383
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Teiko Kawahigashi, Sho Nishiguchi, Joel Branch, Kazuki Hiramitsu, Takayuki Niitsu, Izumi Kitagawa


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.11.037
       
  • Without Further Delay: Lyme Carditis
    • Authors: Ajay K. Sharma; Nureddin Almaddah; Kashif Chaudhry; Sarju Ganatra; Ghulam M. Chaudhry; Jonathan Silver
      Pages: 384 - 386
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Ajay K. Sharma, Nureddin Almaddah, Kashif Chaudhry, Sarju Ganatra, Ghulam M. Chaudhry, Jonathan Silver


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.11.004
       
  • Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic
           Review and Meta-Analysis
    • Authors: Akram Y. Elgendy; Islam Y. Elgendy; Ahmed N. Mahmoud; Mohammad Al-Ani; Mohamed Moussa; Ahmad Mahmoud; Mohammad K. Mojadidi; R. David Anderson
      Pages: 387 - 394
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Akram Y. Elgendy, Islam Y. Elgendy, Ahmed N. Mahmoud, Mohammad Al-Ani, Mohamed Moussa, Ahmad Mahmoud, Mohammad K. Mojadidi, R. David Anderson
      Background Erectile dysfunction has been reported as an adverse effect of statin therapy. Methods We performed a meta-analysis of randomized trials and observational studies that compared statin users versus non-statin users and reported data regarding new onset of erectile dysfunction in men with established cardiovascular disease or cardiovascular disease risk factors. We used DerSimonian-Laird and Peto models to construct the summary estimates risk ratio. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the overall quality of evidence for new-onset erectile dysfunction. Results Three randomized trials and 3 observational studies were identified, with 69,448 men, of whom 24,661 were statin users. Statin use was not associated with an increased risk of new onset of erectile dysfunction by random effects model or fixed effect model (risk ratio 0.96; 95% confidence interval, 0.84-1.10; P = .58; and odds ratio 0.95; 95% confidence interval, 0.88-1.02; P = .20, respectively). This effect was similar in randomized trials and observational studies (P interaction = .86). Randomized trials provided a moderate quality of evidence, and observational studies provided a very low quality of evidence by the GRADE assessment. Random effects meta-regression analyses revealed no difference in treatment effect according to age or diabetes mellitus (P = .83 and P = .74, respectively). Conclusions Among men with established cardiovascular disease or cardiovascular disease risk factors, statin use does not seem to be associated with a new onset of erectile dysfunction. Adequately powered and high-quality randomized trials are recommended to confirm these findings.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.043
       
  • Coaching Patients Saves Lives and Money
    • Authors: Joshua Byrnes; Thomas Elliott; Margarite J. Vale; Michael V. Jelinek; Paul Scuffham
      Pages: 415 - 421.e1
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Joshua Byrnes, Thomas Elliott, Margarite J. Vale, Michael V. Jelinek, Paul Scuffham
      Background The Coaching On Achieving Cardiovascular Health (COACH) Program has been proven to improve biomedical and lifestyle cardiovascular disease (CVD) risk factors. The objective of this study was to evaluate the long-term impact of The COACH Program on overall survival, hospital utilization, and costs from the perspective of a private health insurer (payor), in patients with CVD. Methods A prospective parallel-group case-control study design with controls randomly matched to patients based on propensity score. There were 512 participants with CVD engaged in a structured disease management program of 6 months duration (The COACH Program) who were matched to 512 patients with CVD who were allocated to the control group. The independent variables that estimated the propensity score were preprogram hospital admissions, age, and sex. The primary outcome was overall survival with secondary outcomes, including hospital utilization and cost incurred by the private health insurer. Mean follow-up was 6.35 years. Difference in overall survival between the 2 groups was estimated using a Cox proportional hazard ratio (HR) with difference in total cost estimated using a generalized linear model. Results The COACH Program achieved a significant reduction in overall mortality (HR 0.70; 95% confidence interval [CI], 0.53-0.93; P = .014). There was an apparent dose-response effect: those who received up to 3 coaching sessions had no decrease in mortality (HR 1.02; 95% CI, 0.69-1.49; P = .926); those who received 4 or more coaching sessions had a substantial decrease in mortality (HR 0.58; 95% CI, 0.42-0.81; P = .001). Total cost to the health insurer was substantially lower in the intervention group ($12,707 per person lower; P = .078). The reduction in total cost was significantly greater in those who received 4 or more sessions ($19,418 per person; P = .006) and in males ($18,947 per person; P = .029). Conclusions Those enrolled in The COACH program achieved a statistically significant decrease in overall mortality compared with usual care at 6.35 years. A substantive reduction in hospital costs was also observed among those who received The COACH program compared with those who did not, particularly in those who received 4 or more sessions and in males.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.019
       
  • Blood Transfusion in Elderly Patients with Acute Myocardial Infarction:
           Data from the RICO Survey
    • Authors: Alain Putot; Marianne Zeller; Sophie Perrin; Jean-Claude Beer; Jack Ravisy; Charles Guenancia; Raphaël Robert; Patrick Manckoundia; Yves Cottin
      Pages: 422 - 429.e4
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Alain Putot, Marianne Zeller, Sophie Perrin, Jean-Claude Beer, Jack Ravisy, Charles Guenancia, Raphaël Robert, Patrick Manckoundia, Yves Cottin
      Background Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir. Methods We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey. They were categorized according to their hemoglobin nadir (≤8, >8 to ≤10, and >10 g/dL) and age (<80 or ≥80 years). Results A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir >10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was ≤8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (≥80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016). Conclusion Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was >10 g/dL. However, in patients aged ≥80 years with hemoglobin nadir <8 g/dL, transfusion was associated with a 50% reduction in 1-year mortality.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.09.027
       
  • Value of Patient-Directed Brain Magnetic Resonance Imaging Scan with a
           Diagnosis of Migraine
    • Authors: William J. Mullally; Kathryn E. Hall
      Pages: 438 - 441
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): William J. Mullally, Kathryn E. Hall
      Background The objective of this study was to determine whether a brain magnetic resonance imaging (MRI) scan in patients with a diagnosis of migraine, who insist on the performance of imaging, is of more benefit in detecting clinically significant unsuspected structural abnormalities than would be expected by chance. Methods This prospective, observational, single-center study was performed from January 1, 2010 to December 31, 2012 and included 100 subjects with a diagnosis of migraine and normal results on neurologic examination. A brain MRI scan was performed on all patients, solely at their request, to detect an unsuspected clinically significant structural lesion. Results Of the 100 patients, 86 were female, and the average age was 31.5 years. Forty-five patients experienced migraine without aura, 41 chronic migraine, and 14 migraine with aura. All of the patients had normal results on neurologic examination. The duration of headaches ranged from 4 months to 40 years. In all, 82 of the MRI scans showed normal results, and 17 revealed clinically insignificant abnormalities. One MRI in a patient with chronic migraine without aura revealed a meningioma that subsequently required surgery and radiation therapy. The 1% prevalence of tumor in this study was then compared with 2 large cohorts of MRI abnormalities in the general asymptomatic population, in which tumor was found in 35 out of 3000. Fisher's exact test was used to compare the prevalence of tumor in the study population with the combined cohorts, and there was no statistical difference between these rates (P > .99). Conclusions Brain MRI obtained at the specific request of patients with a diagnosis of migraine in the presence of normal neurologic examination results has a yield that is equivalent to that of the general asymptomatic population. Patients do not seem to have more insight than the examining clinician with regard to detecting underlying structural abnormalities, and brain MRI should not performed as part of the routine evaluation of migraine without a clear clinical indication.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.042
       
  • Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and
           Inflammatory Joint Disease
    • Authors: Faisal Rahman; Seth S. Martin; Seamus P. Whelton; Freny V. Mody; Joban Vaishnav; John William McEvoy
      Pages: 442.e1 - 442.e8
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Faisal Rahman, Seth S. Martin, Seamus P. Whelton, Freny V. Mody, Joban Vaishnav, John William McEvoy
      The epidemiologic data associating infection and inflammation with increased risk of cardiovascular disease is well established. Patients with chronically upregulated inflammatory pathways, such as those with HIV and inflammatory joint diseases, often have a risk of future cardiovascular risk that is similar to or higher than patients with diabetes. Thus, it is of heightened importance for clinicians to consider the cardiovascular risk of patients with these conditions. HIV and inflammatory joint diseases are archetypal examples of how inflammatory disorders contribute to vascular disease and provide illustrative lessons that can be leveraged in the prevention of cardiovascular disease. Managing chronic inflammatory diseases calls for a multifaceted approach to evaluation and treatment of suboptimal lifestyle habits, accurate estimation of cardiovascular disease risk with potential upwards recalibration due to chronic inflammation, and more intensive treatment of risk factors because current tools often underestimate the risk in this population. This approach is further supported by the recently published CANTOS trial demonstrating that reducing inflammation can serve as a therapeutic target among persons with residual inflammatory risk for cardiovascular disease.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.11.034
       
  • Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with
           Atrial Fibrillation
    • Authors: Jennifer J. Huang; Sridhar Reddy; Tam H. Truong; Prakash Suryanarayana; Joseph S. Alpert
      Pages: 442.e13 - 442.e17
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert
      Background The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk. Methods A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis. Results Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec. Conclusions Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2017.10.041
       
  • Acute Onset Unilateral Proptosis
    • Authors: Firas El Chaer; Zeba N. Singh; Ying Zou; Pranshu Mohindra; Maria R. Baer; Jennie Y. Law
      Abstract: Publication date: Available online 13 April 2018
      Source:The American Journal of Medicine
      Author(s): Firas El Chaer, Zeba N. Singh, Ying Zou, Pranshu Mohindra, Maria R. Baer, Jennie Y. Law


      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.021
       
  • Serious Cover-Up: Hodgkin's Lymphoma Masked by Organizing Pneumonia
    • Authors: Amos Lal; Michael J. Davis; Jamal Akhtar; Yayan Chen; Steven Davis
      Abstract: Publication date: Available online 13 April 2018
      Source:The American Journal of Medicine
      Author(s): Amos Lal, Michael J. Davis, Jamal Akhtar, Yayan Chen, Steven Davis


      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.019
       
  • Sickle Cough: A Case of Non-Resolving Pneumonia
    • Authors: Eric Coomes; Paul Bunce
      Abstract: Publication date: Available online 13 April 2018
      Source:The American Journal of Medicine
      Author(s): Eric Coomes, Paul Bunce


      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.030
       
  • Chamber-Made: Mural Endocarditis
    • Authors: Christine Rutlen; Srikanth Vallurupalli
      Abstract: Publication date: Available online 13 April 2018
      Source:The American Journal of Medicine
      Author(s): Christine Rutlen, Srikanth Vallurupalli


      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.027
       
  • Association of Low Hemoglobin with Symptomatic Venous Thromboembolism in
           Acutely Ill Hospitalized Medical Patients: an APEX Trial Substudy
    • Authors: Gerald Chi; C. Michael Gibson; Adrian F. Hernandez; Russell D. Hull; Syed Hassan A. Kazmi; Ahmed Younes; Sargun S. Walia; Anmol Pitliya; Amandeep Singh; Farima Kahe; Arzu Kalayci; Tarek Nafee; Mathieu Kerneis; Fahad AlKhalfan; Alexander T. Cohen; Robert A. Harrington; Samuel Z. Goldhaber
      Abstract: Publication date: Available online 13 April 2018
      Source:The American Journal of Medicine
      Author(s): Gerald Chi, C. Michael Gibson, Adrian F. Hernandez, Russell D. Hull, Syed Hassan A. Kazmi, Ahmed Younes, Sargun S. Walia, Anmol Pitliya, Amandeep Singh, Farima Kahe, Arzu Kalayci, Tarek Nafee, Mathieu Kerneis, Fahad AlKhalfan, Alexander T. Cohen, Robert A. Harrington, Samuel Z. Goldhaber
      Background Anemia is a common finding and independent predictor for adverse outcomes in hospitalized patients with medical illness. It remains unclear whether anemia is a risk factor for venous thromboembolism and whether the presence of anemia can refine risk assessment for prediction of venous thromboembolism, thereby adding incremental utility to a validated model. Methods In the APEX trial, 7,513 hospitalized medical patients were randomized to receive either betrixaban or standard-of-care enoxaparin for thromboprophylaxis. Baseline hemoglobin concentrations were obtained in 6,861 patients with a follow-up of 77 days. Symptomatic venous thromboembolism events, including symptomatic deep vein thrombosis, pulmonary embolism, and venous thromboembolism-related mortality, were compared between low hemoglobin and normal hemoglobin group (normal range: 12.5 to 17.0 g/dL for males and 11.0 to 15.5 g/dL for females). The relationship between anemia and venous thromboembolism events was assessed by fitting a univariable and multivariable logistic regression model composed of thromboprophylaxis and risk factors. Venous thromboembolism risk refinement by hemoglobin measurement was evaluated in the IMPROVE risk assessment model. Results Low hemoglobin at baseline was associated with a greater risk of symptomatic venous thromboembolism (RR=1.94 [95% CI: 1.27–2.98]; p=0.002), symptomatic deep vein thrombosis (RR=2.29 [1.12–4.68]; p=0.019), and non-fatal pulmonary embolism (RR=2.63 [1.22–5.65]; p=0.010) but not venous thromboembolism-related mortality (RR=1.47 [0.71–3.04]; p=0.30). After adjusting for thromboprophylaxis, history of previous venous thromboembolism, intensive or coronary unit admission and D-dimer, low hemoglobin (as a categorical or continuous variable) remained associated with an increased likelihood of venous thromboembolism (adjusted OR=1.71 [1.09–2.69]; p=0.020). Low hemoglobin also improved risk discrimination and reclassification after inclusion in the IMPROVE model. Conclusions Anemia was independently associated with a greater risk of symptomatic venous thromboembolism among acutely ill medical patients despite the provision of thromboprophylaxis. Hemoglobin measurement also improved risk stratification by the IMPROVE venous thromboembolism risk score.

      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.031
       
  • Socrates on Quality
    • Authors: Joseph S. Alpert
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Medicine
      Author(s): Joseph S. Alpert


      PubDate: 2018-04-15T14:02:09Z
      DOI: 10.1016/j.amjmed.2018.03.022
       
  • Ethico-Legal Challenges of Drug Packing - a Case Report
    • Authors: Elijah Verheyen; Tal Shachi; Karan Sud; Bashar Mourad; Paru Patrawalla
      Abstract: Publication date: Available online 11 April 2018
      Source:The American Journal of Medicine
      Author(s): Elijah Verheyen, Tal Shachi, Karan Sud, Bashar Mourad, Paru Patrawalla


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.026
       
  • A Surprising Diagnosis: Syphilitic Gastritis and Hepatitis
    • Authors: Christian L. Horn; Seyed Jalali; Joel Abbott; Michael T. Stein
      Abstract: Publication date: Available online 10 April 2018
      Source:The American Journal of Medicine
      Author(s): Christian L. Horn, Seyed Jalali, Joel Abbott, Michael T. Stein


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.023
       
  • Purulent Pneumococcal Pericarditis: an Uncommon Presentation in the
           Vaccination Era.
    • Authors: Bruno Ali Lopez Luis; Dehydra Monserratt Leon-Tavares
      Abstract: Publication date: Available online 10 April 2018
      Source:The American Journal of Medicine
      Author(s): Bruno Ali Lopez Luis, Dehydra Monserratt Leon-Tavares


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.020
       
  • Learning to De-Adopt Ineffective Healthcare Practices
    • Authors: Kevin Selby; Geoffrey D. Barnes
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Medicine
      Author(s): Kevin Selby, Geoffrey D. Barnes


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.014
       
  • Sudden Creatine Kinase Elevation When an Athlete Starts Boxing: Looking
           Deeper before Knocking the Statin Out
    • Authors: Aakash Bavishi; Travis Howard; Amanda Rosen; Neil J. Stone
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Medicine
      Author(s): Aakash Bavishi, Travis Howard, Amanda Rosen, Neil J. Stone


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.016
       
  • The Simplest Explanation: Pancytopenia
    • Authors: Anubodh Varshney; Ebrahim Barkoudah
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Medicine
      Author(s): Anubodh Varshney, Ebrahim Barkoudah


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.017
       
  • Estimating Time Physicians and Other Healthcare Workers Spend with
           Patients in an Intensive Care Unit Using a Sensor Network
    • Authors: Rachel Butler; Mauricio Monsalve; Geb W. Thomas; Ted Herman; Alberto M. Segre; Philip M. Polgreen; Manish Suneja
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Medicine
      Author(s): Rachel Butler, Mauricio Monsalve, Geb W. Thomas, Ted Herman, Alberto M. Segre, Philip M. Polgreen, Manish Suneja
      Background Time and motion studies have been used to investigate how much time various healthcare professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact using a novel method that does not rely on self-report or human observers. Methods We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among healthcare workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by healthcare workers. Results For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared to 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one healthcare worker of a designated type in their ICU room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (e.g., respiratory therapists, pharmacists). Conclusions Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.015
       
  • Diagnostic Dilemma
    • Authors: Carlo Foppiano Palacios; David J. Riedel
      Abstract: Publication date: Available online 9 April 2018
      Source:The American Journal of Medicine
      Author(s): Carlo Foppiano Palacios, David J. Riedel


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.018
       
  • Caught in the Act: Thrombus Wedged in a Patent Foramen Ovale
    • Authors: Yasmeen K. Tandon; Prasanna Sengodan; Narendrakumar Alappan; Gustavo A. Heresi; Michael Zhen-Yu Tong; Rahul D. Renapurkar
      Abstract: Publication date: Available online 6 April 2018
      Source:The American Journal of Medicine
      Author(s): Yasmeen K. Tandon, Prasanna Sengodan, Narendrakumar Alappan, Gustavo A. Heresi, Michael Zhen-Yu Tong, Rahul D. Renapurkar


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.013
       
  • Is Frailty a Predictor of Outcomes in ElderlyInpatients with Acute Kidney
           Injury'
    • Authors: S. Morton; A. Isted; P. Avery; J. Wang
      Abstract: Publication date: Available online 4 April 2018
      Source:The American Journal of Medicine
      Author(s): S. Morton, A. Isted, P. Avery, J. Wang
      Background Frailty and acute kidney injury are independently associated with an increased risk of morbidity and mortality. The degree of frailty can be assessed by the Clinical Frailty Score (CFS). This study assessed if an individual's CFS was associated with acute kidney injury in acute elderly medical admissions and recorded the short-term outcomes. Methods This was a single-centre prospective observational cohort study. All patients aged ≥65-years admitted under an acute medical take over 12 non-consecutive days were included. Patient demographics, co-morbidities, baseline CFS and renal status on admission were recorded. Outcomes of death, length of stay and hospital re-attendance were assessed two weeks following admission. Results Of 164 patients (77 males) 19% had acute kidney injury on admission and 22% were considered severely frail. Severe frailty was associated with acute kidney injury (p=0.01) and death within two-weeks (p=0.01). Two-week mortality was highest amongst patients with both (36%). Conclusion The incidence of acute kidney injury in ‘severely frail’ acutely unwell elderly patients is significantly higher and associated with an increased short-term mortality. The CFS may be useful in acute illness to guide clinical decisions in elderly patients.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.012
       
  • Twenty Children, Six Teachers, Two Sets of Eyes, a Dog, and a
           Transformation
    • Authors: Daniel G. Federman
      Abstract: Publication date: Available online 4 April 2018
      Source:The American Journal of Medicine
      Author(s): Daniel G. Federman


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.03.011
       
  • 2017 is Banner Year for Drug Approvals by the FDA
    • Authors: Alex M. Ebied; Rhonda M. Cooper-DeHoff
      Abstract: Publication date: Available online 4 April 2018
      Source:The American Journal of Medicine
      Author(s): Alex M. Ebied, Rhonda M. Cooper-DeHoff
      In 2017, the US Food and Drug Administration approved 46 novel drugs and 29 drugs received newly approved indications. This record setting year was due in part to the new expedited review pathways. A review of these drugs were summarized.

      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.02.034
       
  • Oral Anticoagulation for Primary Prophylaxis of Venous Thromboembolism in
           Cancer Patients
    • Authors: Wilbert S. Aronow; Tatyana A. Shamliyan
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Medicine
      Author(s): Wilbert S. Aronow, Tatyana A. Shamliyan


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.02.029
       
  • On Becoming a Woman
    • Authors: Helaine Kwong; Paul ORourke
      Abstract: Publication date: Available online 3 April 2018
      Source:The American Journal of Medicine
      Author(s): Helaine J. Kwong, Paul D. O'Rourke


      PubDate: 2018-04-11T13:46:09Z
       
  • Management of Opioid-Induced Constipation in Patients with Malignancy
    • Authors: Jose M. Garcia; Tatyana A. Shamliyan
      Abstract: Publication date: Available online 2 April 2018
      Source:The American Journal of Medicine
      Author(s): Jose M. Garcia, Tatyana A. Shamliyan


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.02.038
       
  • Honoring a Patient: From Suspicion to Diagnosis
    • Authors: Samuel Rosner; Emily R. Insetta
      Abstract: Publication date: Available online 2 April 2018
      Source:The American Journal of Medicine
      Author(s): Samuel Rosner, Emily R. Insetta


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.02.035
       
  • Invisible Elephants
    • Authors: Shanon Peter
      Abstract: Publication date: Available online 2 April 2018
      Source:The American Journal of Medicine
      Author(s): Shanon Peter


      PubDate: 2018-04-11T13:46:09Z
      DOI: 10.1016/j.amjmed.2018.02.036
       
  • Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in
           Cancer Patients with Venous Thromboembolism
    • Authors: Chatree Chai-Adisaksopha; Alfonso Iorio Mark Crowther Javier Miguel Estuardo Salgado
      Abstract: Publication date: April 2018
      Source:The American Journal of Medicine, Volume 131, Issue 4
      Author(s): Chatree Chai-Adisaksopha, Alfonso Iorio, Mark A. Crowther, Javier de Miguel, Estuardo Salgado, Marija Zdraveska, Carmen Fernández-Capitán, José Antonio Nieto, Giovanni Barillari, Laurent Bertoletti, Manuel Monreal
      Background Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. Results After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). Conclusions In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.

      PubDate: 2018-04-11T13:46:09Z
       
 
 
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